Provider Demographics
NPI:1043305782
Name:LONG BEACH CARE CENTER, INC.
Entity Type:Organization
Organization Name:LONG BEACH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-426-6141
Mailing Address - Street 1:2615 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1708
Mailing Address - Country:US
Mailing Address - Phone:562-426-6141
Mailing Address - Fax:562-426-5269
Practice Address - Street 1:2615 GRAND AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1708
Practice Address - Country:US
Practice Address - Phone:562-426-6141
Practice Address - Fax:562-426-5269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA940000177314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1140935OtherMEDICAL PIN NUMBER
CAZZT056188HMedicaid
CA056188Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER